Elsevier

Epilepsy & Behavior

Volume 70, Part B, May 2017, Pages 280-287
Epilepsy & Behavior

Review
Social factors in marijuana use for medical and recreational purposes

https://doi.org/10.1016/j.yebeh.2016.11.011Get rights and content

Abstract

Of all the various treatment options for epilepsy, no other therapy comes close to the polarity that cannabis engenders. The rationale for this reaction is firmly rooted in the social factors that enshroud the use of marijuana for both medical and recreational purposes. In order to best understand how to approach this controversial treatment, it is essential to explore the social, demographic, and historical variables that have led to the current opinions on cannabis therapy and how this has converged on epilepsy treatment. Utilizing a sociological conceptual framework, this review discusses in depth the social, cultural, and historical dimensions of cannabis use in the US for medical purposes and its impact on epilepsy treatment. Moreover, it posits that cannabis therapy and the opinions surrounding its use are products of history and assesses this treatment option through the lens of our current times.

This article is part of a Special Issue titled Cannabinoids and Epilepsy.

Introduction

Marijuana refers to the dried leaves, flowers, stems, and seeds from the hemp plant Cannabis, which contains several compounds known as cannabinoids, most notably the psychoactive (mind-altering) chemical delta-9-tetrahydrocannabinol (THC), as well as other compounds such as cannabidiol (CBD). There are two varieties of cannabis, Cannabis sativa and Cannabis indica. Research has shown that these two species produce different effects, probably due to different concentrations of the main components; C. sativa plants have a higher ratio of CBD/THC while the opposite is true of C. indica plants [1]. Marijuana is the most commonly used illicit drug in the US. Marijuana is smoked in hand-rolled cigarettes (joints), pipes, or water pipes (bongs); it is also mixed in food or brewed as tea. The short-range effects of marijuana include problems with memory and learning, distorted perception, difficulty in thinking, and loss of coordination. Among youth, heavy cannabis use is associated with cognitive problems and increased risk of mental illness [2].

In 2013, 7.5% (19.8 million) of the US population aged 12 years and older reported using marijuana during the preceding month [3]. Marijuana use is often considered a behavioral problem, but marijuana use is also – and perhaps foremost – a sociocultural phenomenon. Humans discovered marijuana in ancient times, and marijuana has been used for medicinal, ceremonial, and recreational purposes by people around the world (see [4], [5] for a review). Marijuana is an illegal substance under the current US federal regulations. Specifically, in 1937, the US government made cannabis possession and transfer illegal and punishable by law. However, many states in recent years have legalized or considered to legalize marijuana for medicinal or recreational purposes. Although the public opinion on marijuana legalization is divided, legal restrictions and social attitudes toward marijuana are relaxing, and cannabis products are becoming more accessible [3]. With these changes, there are continuing and increasing concerns in the US about marijuana use among at-risk populations, especially youth [6], [7] as well as about the effectiveness of cannabis-based treatments for health problems. In particular, there is a growing body of literature regarding the use of cannabinoids for a variety of neurological conditions, most notably multiple sclerosis [5], [8], [9], [10], [11], [12] and epilepsy, and clinical trials are under way [13]. These developments call for a closer examination of social factors in marijuana use. So, what are these social factors and how are they associated with marijuana use?

The use of marijuana is inextricably linked with the key components of human societies – culture, polity, economy, law and order, and other aspects of social life (population/demographic profile, science, health, social stratification, etc.). Here are potential questions that address the different social dimensions of marijuana and marijuana use: (1) Culture: What are the cultural conceptions of marijuana (what it is, what purpose it serves)? What are the social attitudes toward marijuana use and different types of use? (2) Politics: What is the society's formal position (policy) on marijuana and marijuana use? Is marijuana regulated? If so, what aspects and how? Is the political/policy discourse changing and how? (3) Law and order: How are marijuana-related laws and regulations enforced? What penalties are there for breaking the laws/regulations? Who are the offenders and what is their motivation? (4) Economic: How is marijuana produced and distributed? What is the profile of producers, distributors, and consumers? (5) Science and health: What is the scientific evidence regarding recreational marijuana use and as treatment for health problems/conditions? What are the attitudes of patients and providers toward marijuana use for medical reasons?

The purpose of this review is to present and organize what is known about the social aspects of marijuana use. Sociological perspectives – social constructionism, post-structuralism, deviance, medicalization, population health, and social determinants of health – will provide a conceptual framework for understanding the place of marijuana in American society. The aim is to delineate directions for future research that considers social dimensions of marijuana use, especially as treatment for medical conditions, including epilepsy/seizure disorders.

Section snippets

Conceptual framework

Any discussion of social factors in health requires a sociological lens. Several sociological perspectives are particularly useful in conceptualizing, contextualizing, and analyzing cannabis use. We provide a brief overview of these perspectives, which are not fully independent but rather build upon and complement each other.

Current knowledge

What do we actually know about social aspects of marijuana use? Below we review the relevant literature and other information that fits into the different social dimensions, such as culture, policy and law, sociodemographic trends, social status determinants of use, and so on.

Summary and conclusion

There is an extensive literature about the patterns of marijuana use and related problems in the US population and specific subgroups. There is also an emerging knowledge about the social discourse regarding marijuana use for recreational and medical purposes, but it is dispersed across disciplinary literatures and other sources. Policy and legal studies and government documents have focused on regulation and recent trends in marijuana legalization. Medical researchers have been seeking and

Post-script

In November 2016, nine states will vote on ballot measures that increase access to marijuana, which would have significant ripple effects [58]. Marijuana could become legal in the entire US West Coast and in additional states (e.g., Arizona and Nevada). This would provide a stronger challenge to the federal government's ban as well as reignite the legalization debate in neighboring countries/region such as Mexico and Latin America. Furthermore, if the largest state economy, California, approves

Funding

This research did not receive any direct grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare no conflicts of interest.

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